Beyond antidepressants

Camus famously implored us to ‘imagine Sisyphus happy’. Philosopher Carl Elliot asks us to imagine a different scenario: what if Sisyphus – the Greek mythological hero condemned for eternity to push a boulder up a hill only to have it roll back down again – was instead depressed, and lived in the modern world? Would we, asks Elliott, prescribe him an antidepressant so that he could undertake his unending labour with more enthusiasm? Should we?

The proof that antidepressants work – although they do not work for everyone, and have a number of possible side effects that range from moderate to severe – is not a surprise to me. I am one of the nearly ten per cent of Australians taking them, and I have experienced their benefits first hand.

Yet to end the discussion there – antidepressants work, let’s pop some more pills – would be a grave mistake. If we wish to properly treat and fully understand depression (and its closely related cousin, anxiety) in contemporary society, we cannot ignore the social and existential dimensions of these all too common ailments.

Antidepressant use has risen in the West (prescriptions have doubled in Australia since 2000) largely because depression and anxiety are now viewed as biological illnesses caused by chemical imbalances in the brain. As Helen Razer has written, where once the medical profession understood depression as having two distinct ‘types’ – emanating from within (biological) and from without (psycho-social) – it now assumes all depression is biological and thus treats it with medication, often as a first resort. In recent decades, time-poor GPs and patients looking for quick fixes have all too readily chosen pills over therapy to treat depression, much to the delight of profiting drug companies.

But there is a bigger picture. These worrying disparities – while very good reasons to reduce inequality and bulk-bill mental health services – do not touch upon the fact that depression and anxiety are rising in modern societies to the point where they are becoming part of the texture of everyday life. Depression is increasing worldwide but is most common in western societies, where a growing number of people feel – as I have – a persistent, low-level dread, numbness or sadness in trying to meet the demands of modern life. The reason for this is that we live, as Guy Rundle has argued, in a ‘depressogenic society’.

Our fiscal and monetary policies are not all that has been transformed since the triumph of neoliberalism in the 1980s. The very nature of collective life has changed, as the market has reached further into areas of everyday life, and Western societies have been remodelled on the doctrine of individualism writ large. We live more isolated, less settled lives; ones no longer dependent upon community for shared meaning or social identity. We have, at least partially, achieved Margaret Thatcher’s infamous vision that ‘there’s no such thing as society.’

On top of a lack of abiding communities, institutions and collective meanings, as well as the confusion of young adulthood, Millennials must also contend with the anonymity of the mass university, where their degrees are becoming more expensive, of poorer quality, and being less able to secure a job in an employment market flooded by graduates. Young people must then navigate insecure workplaces – not to mention living conditions – and are expected by their employers to constantly ‘upskill’ to meet the demands of an ‘agile’ and ‘innovative’ world, in which ‘disruption’ will, we’re told, lead to seven career changes in our lifetimes (that’s if the robots don’t take our jobs first).

This instability contributes to an unstable sense of self, amplified by a brand of insecure narcissism that is fostered by social media. We require constant validation from others, but only ever achieve it ephemerally, and only for the ‘curated’ selves we present online. In the face of all this, Millennials often must fake happiness: along with cultural imperatives to be cheerful, many of the jobs in which young people tend to be employed – hospitality, creative and artistic industries, knowledge work at your ‘passion’ – demand a relentless, enforced positivity. No wonder, then, that we are fucking depressed.

The political consequences of all this should be clear: anxiety and depression are not merely medical problems; they are also social and political ones. To solve these problems, we must work together to alter our shared conditions of living: by reducing economic inequalities, re-invigorating social solidarity and reviving the most beneficial aspects of community.

The idea that much of the depression we experience in the West is a product of our environment points towards another, more personal, dimension of depression that is also neglected when we see antidepressants as a panacea. Rather than merely illnesses we have, depression and anxiety are often proper – or at least natural – responses to circumstances that some part of us does not wish to endure.

Carl Elliott has argued that much of what is commonly treated with antidepressants might better be described as alienation. Alienation, writes Elliott, is when we feel a disjuncture between the shape of our lives and how we wished things could be, when we feel we do not know who we are, or – as might be the case with much of the dynamic, ‘globalised’ world – when we ‘sense that a particular form of life is changing beneath our feet.’

This kind of depression, however uncomfortable, is not necessarily something to be wished away. Anxiety or depression that is born of a deep discomfort with our lives is, as Philosopher Samir Chopra writes, ‘a message from ourselves’. Yet when antidepressants are prescribed as a first – and especially only – resort, we are deaf to this message, and we are not encouraged to re-evaluate the shape of our lives, and (if possible) live them better and more in accord with our deepest values. While depression is often caused by social structures, it is experienced at the level of the self, and must be partly combatted as such with introspection and talking therapies.

Antidepressants work. For me, they have helped lift me out of a deep slump, but had I been prescribed them alone, I would not have sought – with the help of a fantastic psychologist – a deeper understanding of myself; one that acknowledged that my depression was partly existential anguish at the direction my life had taken. An unpromising job market had made me desperate for work, which compounded my own personal anxieties about pleasing people, making it harder to leave a job I hated. Thus the deepest facts of my psyche met with the political and cultural conditions of the day.

Historian of medicine Roy Porter once wrote that we are seeing ‘the idioms of the psychological and the psychiatric replace Christianity and humanism as the ways of making sense of self.’ We might do well to re-engage some of these older understandings: ones in which the human being is not a pill-popping bunch of chemicals but a complex self, inextricably intertwined with our social and cultural conditions, and with deep existential needs. If we truly wish to address depression and anxiety in modern society, we should do more than merely prescribe antidepressants. We must reflect on our Sisyphean tasks and decide – collectively, and as individuals – whether the boulders we have been condemned with are really worth pushing up the hill.

Comments

Gavin, I’d agree with you and so would almost every other psychiatrist. Antidepressants have a definite role in some cases, but in 30 years of practice, I’m yet to see anyone resolve their Depression with antidepressants alone. The mainstream view in psychiatry would see therapy as the cornerstone of treatment. Of course, resolving your Depression may still leave you unhappy, but unhappiness is different from Depression

Yes, boulder and pills remain the conundrum, along with pharmaceutical companies and states reaping huge profits from misfortune, both not bothering to work on and advocate healthier forms of society and medicine.

Legit, depression and anxiety are logical outcomes of and self-destructive behaviours are proportionate responses to unreasonable conditions. I would love to live in a world where responses to depression weren’t “let’s fix you” but “yeah, you’re right, world is fukt, it’s ok to be said and you can spiral into ‘unproductiveness’ without becoming destitute/indebted”. Only thing I’d say is that I reckon many people dealing with mental illness aren’t necessarily deaf to the “message from ourselves”; they just know they literally can’t afford to respond to that message carefully when they’re in precarious work or risk failing subjects/having candidature lapse if they take even a few weeks to really listen. I’ve had several instances in which I’d have loved to stop pushing boulders up the hill but couldn’t risk my material conditions for a desperately needed breather. I don’t think it’s ignorance so much as compromise (the latter of which can bring about more guilt and pain).

Also if you haven’t already I’d recommend you checking out Nikolas Rose’s work on our ‘neurochemical selves’, god stuff.